Eating ability predicts subsequent quality of life in Chinese patients with breast, liver, lung, or nasopharyngeal carcinoma: A longitudinal analysis

Figures & data

Figure 1.  Sampling structure and attrition pattern of the study.

Table I.  Socio-demographic and clinical characteristics of the study sample at baseline (n = 1 079).

	BC (n = 250)	LiC (n = 253)	LuC (n = 334)	NpC (n = 242)	p-value
Mean age (yrs)	48	57	65	49	<0.001
Sex (%)					<0.001
Male	–	82	76	73
Female	100	18	24	27
Marital status (%)					<0.005
Single	6	5	6	10
Married/Cohabiting	82	80	78	83
Divorced/Separated	5	3	2	3
Widowed	7	12	14	4
Education (%)					<0.001
No formal education	17	22	28	14
Primary	37	42	46	39
Secondary	40	31	23	37
Tertiary	6	5	3	10
Occupation (%)					<0.001
Full-time	33	39	18	57
Part-time	3	1	1	3
Retired/housewife	55	48	74	29
Unemployed	9	12	8	11
Cancer stage at diagnosis (%)					–
Zero	3	–	<1	–
I	14	–	13	7
II	67	–	11	34
IIIa	14	–	50	47
IIIb	–	–	23	9
IV	2	–	3	2
X^a	–	–	–	1
Histology ^b (%)					–
Non-small cell	–	–	88	–
Small cell	–	–	12	–
Recurrence after baseline^c (%)					<0.001
No	93	94	77	89
Yes	7	6	23	11
Treatment between baseline and FU1^d (%)					<0.001
No	10	48	24	4
Yes	90	52	76	96
Treatment between FU1 and FU2^e (%)					<0.001
No	24	78	79	82
Yes	76	22	21	18
Duration between baseline and FU1 (months)	3.20	1.95	3.33	3.25	<0.001
Duration between FU1 and FU2 (months)	3.22	1.57	3.22	3.47	<0.001
Follow-up completed via telephone interview (%)
FU1	30.4	60.2	52.4	27.3	NS^f
FU2	52.4	58.0	58.6	54.6	NS^f

Note: BC: Breast cancer; LiC: Liver cancer; LuC: Lung cancer; NpC: Nasopharyngeal cancer; FU1: Follow-up 1; FU2: Follow-up 2. FACT-G (Ch): Functional Assessment of Cancer Therapy General Measure (Chinese version); Tot: Total score; Phy: Physical subscore; Soc/Fam: Social/Family subscore; Fnt: Functional subscore; Emt: Emotional subscore; NS: Not significant p-value at 0.05 level.

^aTumor stage unknown, but not Stage IV.

^bApplicable to the lung cancer sample only.

^cRecurrence documented from after baseline to 1 month after the second follow-up.

^dDocumented at the first follow-up interview.

^eDocumented at the second follow-up interview.

^fComparisons of QoL, eating, and pain sores between patients performed face-to-face interview and patients performed telephone interview at FU1 and FU2.

Figure 2.  a-c. Eating function mean scores over time plotted by cancer groups.

Table II.  Linear mixed effects analysis: Mean comparisons of QoL, eating, pain, and depression scores across times and across cancer groups.

	Standardized Beta Coefficient
		Cancer Site^a
Variables^c	Time^2b	BC	LiC	LuC
FACT-G (Ch) Tot	0.006	0.112	−0.532**	−0.649**
FACT-G (Ch) Phy	0.005	0.056	−0.456**	−0.526**
FACT-G (Ch) Soc/Fam	0.016*	0.049	−0.173	−0.295**
FACT-G (Ch) Fnt	−0.002	0.311**	−0.473**	−0.677**
FACT-G (Ch) Emt	0.005	−0.086	−0.358**	−0.296**
Eating ability	0.117*^e	0.753**	−0.032	−0.112
Eating appetite	0.009	0.348**	−0.357**	−0.465**
Eating enjoyment	0.009	0.753**	0.181	0.046
Current pain^d	0.005	−0.134	0.130	0.311**
Average pain^d	0.013*	0.015	0.101	0.216*
Worst pain^d	0.014*	−0.187*	−0.052	0.262**
Depression	0.009	−0.152*	−0.403**	−0.351**

Note: FU1: Follow-up 1; FU2: Follow-up 2; BC: Breast cancer; LiC: Liver cancer; LuC: Lung cancer; NpC: Nasopharyngeal cancer; FACT-G (Ch): Functional Assessment of Cancer Therapy General Measure (Chinese version); Tot: Total score; Phy: Physical subscore; Soc/Fam: Social/Family subscore; Fnt: Functional subscore; Emt: Emotional subscore.

^aComparison of mean scores across group. Reference group: NpC.

^bComparison of mean scores across time; asterisk indicates significant non-linear change.

^cHigher scores indicate better well-being unless otherwise stated.

^dLower scores indicate less pain.

^eAsterisk indicates significant linear change

* p < 0.05.

** p < 0.001.

Table III.  Linear mixed effects models for FACT-G (Ch) scores.

Model	Std β	95% CI	p-value
Model 1: FACT-G (Ch) Tot
Marital status	0.131	0.021, 0.241	0.020
Occupation	0.211	0.108, 0.314	<0.001
Cancer site			<0.001
Breast	−0.133	−0.291, 0.025	NS
Liver	−0.300	−0.508, −0.092	0.005
Lung	−0.324	−0.473, −0.176	<0.001
Nasopharyngeal	0
Eating ability	0.091	0.025, 0.157	0.007
Eating appetite	0.136	0.064, 0.208	<0.001
Eating enjoyment	0.163	0.104, 0.222	<0.001
Worst pain	−0.174	−0.238, −0.109	<0.001
Depression	0.416	0.374, 0.458	<0.001
Model 2: FACT-G (Ch) Phy
Age	0.046	0.000, 0.092	0.048
Occupation	0.117	0.009, 0.224	0.033
Endorsing a religion	−0.098	−0.195, −0.002	0.045
Cancer stage at diagnosis	−0.128	−0.242, −0.013	0.029
Cancer site			0.023
Breast	−0.221	−0.385, −0.056	0.009
Liver	−0.177	−0.394, 0.040	NS
Lung	−0.198	−0.353, −0.042	0.013
Nasopharyngeal	0
Eating ability	0.101	0.032, 0.170	0.004
Eating appetite	0.200	0.124, 0.275	<0.001
Eating enjoyment	0.150	0.089, 0.211	<0.001
Worst pain	−0.240	−0.307, −0.173	<0.001
Depression	0.235	0.192, 0.279	<0.001
Model 3: FACT-G (Ch) Soc/Fam
Marital status	0.676	0.511, 0.841	<0.001
Worst pain	−0.118	−0.214, −0.022	0.016
Depression	0.150	0.087, 0.212	<0.001
Model 4: FACT-G (Ch) Fnt
Occupation	0.157	0.037, 0.277	0.011
Cancer site			<0.001
Breast	0.001	−0.184, 0.185	NS
Liver	−0.209	−0.452, 0.035	NS
Lung	−0.379	−0.553, −0.205	<0.001
Nasopharyngeal	0
Eating ability	0.162	0.085, 0.239	<0.001
Eating appetite	0.120	0.036, 0.204	0.005
Eating enjoyment	0.149	0.080, 0.217	<0.001
Depression	0.297	0.218, 0.316	<0.001
Model 5: FACT-G (Ch) Emt
Occupation	0.155	0.041, 0.269	0.008
Eating appetite	0.117	0.037, 0.197	0.004
Depression	0.644	0.598, 0.691	<0.001

Notes: FACT-G (Ch): Functional Assessment of Cancer Therapy General Measure (Chinese version); Tot: Total score; Phy: Physical subscore; Soc/Fam: Social/Family subscore; Fnt: Functional subscore; Emt: Emotional subscore; Marital status: Non-single/Single; Occupation: Working/Not working; Endorsing a religion: Yes/No; Cancer stage at diagnosis: More advanced/Less advanced; Std β: standardized beta coefficient; CI: confidence interval; NS: Not significant p-value at 0.05 level.

Appendix 1. Number of Items Assessing Eating Function in FACIT and EORTC QLQ.

Instrument	Total No. of Items	Appetite	Swallowing	Eating ability	Eating enjoyment	Total No. of Eating Items
FACIT
Generic measure
FACT-G	27
FACT-GP	22
FANLTC	27
Site specific measures
Bladder	13	1 (C6)				1
Brain	23
Breast	10
CNS	12
Cervix	15	1 (C6)		1 (HN1)		2
Colorectal	10	1 (C6)				1
Endometrial	16
Esophageal	17	1 (C6)	6 (E1, E2, E3, E4, E5, HN7)	2 (HN1, HN5)	1 (E6)	10
Gastric	19	1 (GA1)	1 (GA12)	2 (GA6, HN1)	3 (E6, GA4, GA9)	7
Head & Neck	12		1 (HN7)	3 (HN1, HN5, HN11)		4
Hepatobiliary	18	1 (C6)				1
Leukemia	17	1 (C6)				1
Lung	10	1 (C6)				1
Lymphoma	15	1 (GA1)				1
Ovarian	12	1 (C6)				1
Prostate	12	1 (C6)				1
Vulva	19	1 (C6)				1
EORTC QLQ
Generic measure
C-30	30	1				1
Site specific (validated) modules
Breast	23			1		1
Head & Neck	35		4	3	3	10
Lung	13		1			1
Oesophageal	18		2	4	2	8
Ovarian	28			1		1
Palliative care	15	1				1
Stomach	12			7	2	9

Note: FACIT: Functional Assessment of Chronic Illness Therapy; FACT-G: Functional Assessment of Cancer Therapy-General Measure; FACT-GP: Functional Assessment of Cancer Therapy-General Population; FANLTC: Functional Assessment of Non-Life Threatening Conditions; EORTC QLQ: European Organization of Research and Treatment of Cancer Quality of Life Questionnaire; C-30: Core Questionnaire; Original item codes denoted in parentheses.